Community Medicine

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    An Overview of Rehabilitation Services Offered in the North Texas Area
    (2017-03-14) Newey, Carter; Whitaker, Zachary; Huntzinger, Jake; Meiling, James
    Objective: Rehabilitation medicine is concerned with improving function through the diagnosis and treatment of health conditions, reduction of impairments, and prevention of complications. The health conditions treated by a rehabilitation team span from traumatic brain injury to gait disorders. This unique field relies heavily on the coordination of a multifaceted team of physicians, therapists, social workers, nurses, dieticians and many more. New advances of the technology in areas such as pharmacologic therapy, prosthetics and other mobility assistance devices are the cutting edge of this dynamic field. With its emphasis on improving the quality of life, rehabilitation services are a vital part of providing the best possible patient centered health care. The purpose of this study was to investigate the rehabilitative services available to the residents of the North Texas area and provide a useful summary of each program for the benefit of healthcare providers who might seek this assistance for their patients. Methods: This poster utilized and summarized the resources available on each the five participating program’s websites. Results: The Texas Department of Assistive and Rehabilitative Services Vocational Rehabilitation Program helps individuals who have physical or mental disabilities to find employment. Helping Restore Ability provides a means for individuals who have disabilities to stay in their own homes, rather than having to relocate to a hospital or skilled nursing facility. Texas Technology Access Program helps individuals gain access to assistance devices and equipment to enhance their function and independence. Comprehensive Rehabilitation Services helps individuals with traumatic brain injuries or spinal cord injuries to receive the required care that they need. REACH Resource Centers on Independent Living aids individuals as they strive to lead independent lives. Conclusions: North Texas offers a variety of options to individuals who are in need of rehabilitative services. Ultimately, the goal of each program is to enhance an individual's functional ability and independence by providing each person with the tools, guidance, and opportunities they need in order to live more fulfilling lives.
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    Current Endeavors to Support the Homeless Population of Fort Worth
    (2017-03-14) Alavi, Michael; Burgess, Lauren; Dolan, Kathryn J.; Phillips, Kaitlin
    Purpose: The aim of this research was to identify and explore current solutions in supporting the homeless population in Fort Worth, Texas, particularly through the services provided by local non-profit organizations. Methods: We identified the terms of eligibility, services provided, service access, and barriers to effective outreach provided by five local non-profit organizations, including John Peter Smith Health Network, Tarrant County Samaritan Housing, Arlington Life Shelter, Salvation Army DFW, and Union Gospel Mission of Tarrant County. Results/Conclusions: Frequent terms of eligibility include valid U.S. identification and proof of low-income or homeless status, and common service access methods include hospital referrals, word of mouth, and flyers in well-populated public areas. Services provided included shelter, aid in employment search, navigation to health services, and a variety of supportive services to integrate those who have been recently homeless into society. These organizations have encountered multiple barriers to effective outreach, such as client mental illness, client lack of appropriate paperwork, shortage of affordable housing, and transportation difficulties. Non-profit organizations in Fort Worth provide varying degrees of support for the homeless population and have identified areas for improvement that that citizens, volunteers, local government, and the organizations themselves can consider in broadening their outreach.
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    An Evaluation of Socioeconomic Factors and Health Status on Health-Related Quality Of Life (HRQoL) in Rural Texas
    (2017-03-14) Sanchez, Roberto; Abraham, Stacy; Mamun, Md Abdullah; Gibson, John Dr.; Urbanczyk, Rachel
    Purpose: HRQoL allows us to focus on how the individual perceives his or her own impairments of health. HRQoL in rural areas is rarely examined, yet its measurements can help identify significant health disparity issues and community burdens that will further highlight the needs in communities. We hypothesized that demographic factors and mental illness would have a significant impact on HRQoL in rural Texas communities. Methods: A cross-sectional survey in the form of a questionnaire was completed by 191 patients in 2 different rural Texas communities. Survey questions were taken from the CDC Health Related Quality of Life-14 “Healthy Days Measure” system and from the Behavioral Risk Factor Surveillance System questionnaire. Relationship of socioeconomic factors and health status with HRQoL were assessed using univariate and multiple variable analysis. Wilcoxon signed rank test was used to examine the mean number of unhealthy days in Texas versus the two rural communities in the study. Results: After adjusting for age and gender, we found that on average Hispanics reported a significantly less number of physical or mental unhealthy days in comparison to Whites (p-value = 0.0167). We also found that people with high income reported significantly less number of physical and mental unhealthy days on average (p-value for Conclusions: The results suggest that HRQoL can be influenced by many factors, including income level, race, and location. Our results identified that mental health factors are an important component affecting HRQoL and should be studied further in rural Texas communities. Focus on mental health programs and economic development could be beneficial for these communities.
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    JPS Community Clinics
    (2017-03-14) Corjay, Ryan; Gnasigamany, Jason; Griffin, Brandon; Luu, Stephanie; Dolan, Kathryn J.; Vandermause, Matthew
    Objective: Approximately 41 million Americans are thought to be living in poverty which includes 21% of all children and 12% of adults and translates into 291,534 individuals in Tarrant County. Low-income individuals often lack access to the most basic primary health care services, including women’s health, pediatric services, and basic dental care. This project was undertaken to identify the safety net of community-based healthcare for people living in poverty in Tarrant County. Materials and Methods: The following JPS community clinic resources were identified using, Tarrant County 211 websites, the JPS website, and visits to the JPS main hospital and Viola Pitts/Como Community Health Center. Results: This led us to identify the most significant nonprofit primary health care resources provided by the Tarrant County Hospital District, JPS Health Network, which includes comprehensive community health clinics as well as school-based clinics. Careful consideration of the community clinic capacities, eligibility requirements, and overall barriers to care experienced by individuals suggests the JPS community clinics are providing a much-needed healthcare service in Tarrant County. JPS continuously adapts to the changing needs of the underserved community by delivering culturally competent care to very diverse patient populations and by implementing the community needs assessment and improvement plan. Additionally, JPS trains its workforce to deliver patient education for self-management of chronic conditions such as hypertension and diabetes. Conclusions: JPS Health Network provides broad medical coverage for persons in poverty and for persons without adequate access to health care in Tarrant County through the JPS community clinics. Room for improvement in health coverage was identified as the need for increased access to care for persons with behavioral health issues, the need for expansion of school-based clinics, new and improved modalities for patient education, and further reduction of preventable ED visits.
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    Preventing 30 Day Hospital Readmissions Through Predictor Identification
    (2017-03-14) Knebl, Janice; Allen, John; Larrabee, Rachel
    Introduction: Safe Transitions for Elderly Patients (STEP) is an in-home transitional care service for Medicaid eligible adults aged 50 and older with the goal of ameliorating the CMMS national average rate 21.6% (2013) of patients’ readmission to the hospital within 30 days of discharge. The purpose of the project is to identify potential modifiable clinical and non-clinical factors that will improve patient safety and reduce rehospitalization rates for this vulnerable population. Methods: The study design is a retrospective cohort study of data collected from 498 patients age 50 and older that were enrolled in the STEP program. Exclusion criteria from the original data includes all patients without a BMI assessment, a risk stratification, a transportation assessment, a living assessment, and anyone who was not asked about their primary care provider (PCP). The remaining data was analyzed with respect to readmission status, medical conditions, and risk stratification classification. Comparisons were analyzed using SPSS statistical software including chi-square testing and odds ratio analysis. Results: The readmission rate for the patients included in this study 19.5%. The odds ratio revealed that age greater than 65 (2.02, 95% CI 1.23-3.24), seven to eleven diagnoses at readmission (1.75, 95% CI 1.12-2.74), High Risk Stratification (2.81, 95% CI 1.70-4.63), CHF (2.00, 95% CI 1.22-3.28), and COPD (1.74, 95% CI 1.08-2.79) were each individually associated with higher odds of readmission within 30 days. Living alone was associated with lower rate of readmission within 30 days (0.53, 95% CI 0.30-0.93). Data collected that that proved to be statistically not significant included pain scale rating greater than 6, not having a primary care provider, limited transportation, diabetes mellitus type 2, obesity, and hypertension. Conclusions: The individual factors—age greater than 65, High Risk Stratification, CHF, and COPD—are significant predictors of readmission within 30 days post discharge within this population. Knowing about these factors will help design transition of care programs that target this high-risk population.